Access to reliable medical images is essential for clinical training. To address this need, this paper presents an extended version of MIRAGE, a multimodal retrieval and generation system that utilizes a shared latent space to process medical queries by retrieving real images from the ROCO dataset, generating synthetic scans, and providing LLM-based clinical descriptions alongside dual-concept visual comparisons. To overcome previous computational limits and the lack of clinical validation, we introduce three core enhancements: first, an Auto-$\alpha$ module to dynamically weight visual and textual similarities; second, the integration of LCM-LoRA to accelerate synthetic image generation; and third, an automated clinical auditor based on Gemini 2.5 Flash. Experimental results demonstrate that Auto-$\alpha$ improves retrieval accuracy for heterogeneous queries, reaching $38.83$% Top-1 Recall over a 65,419-image gallery and outperforming nine fusion baselines evaluated under a unified configuration, with a controlled ablation attributing most of this gain to learning the weight rather than merely making it query-adaptive, while the LCM-LoRA module reduces computational costs by a factor of 12.5× in CPU environments, with a blinded radiologist evaluation confirming only a small drop in clinical quality. Furthermore, the clinical auditor achieves a 0.805 Pearson correlation against an expert radiologist, effectively correcting the systematic overestimation of traditional CLIP scores. Finally, the optimized platform is publicly deployed on Hugging Face.